Provider Demographics
NPI:1295336329
Name:COMMUNITY MATTERS OUTPATIENT PSYCHIATRIC CLINIC FOR CHILDREN, INC.
Entity type:Organization
Organization Name:COMMUNITY MATTERS OUTPATIENT PSYCHIATRIC CLINIC FOR CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TANGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCDOUGALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-282-8882
Mailing Address - Street 1:122 HARBISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3013
Mailing Address - Country:US
Mailing Address - Phone:860-282-8882
Mailing Address - Fax:860-282-8890
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3305
Practice Address - Country:US
Practice Address - Phone:860-282-8882
Practice Address - Fax:860-282-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health